2019

Industry Trends Report

Physical Medicine and Workers’ Comp

Welcome to the third annual Industry Trends Report for Physical Medicine in Workers’ Compensation. As the leading provider of managed physical medicine for the workers’ compensation industry, MedRisk has always been dedicated to understanding and advancing best practices. By sharing the most meaningful changes we’ve seen in the wider community over the last year and the insights into where PT for workers’ comp is going next, we hope to make an even larger impact on increasing patient-focused care and improving return-to-work success for patients, providers and employers alike.

MedRisk by the Numbers

MedRisk is the largest specialty managed care organization in the workers’ compensation industry that is dedicated to physical rehabilitation.

559,783

Injured Workers Treated in 2019

Time-to-Treatment

4 hours to Scheduling

2.6 Days

to initial evaluation

100 %

U.S. BASED Service Model

98.1 %

PATIENT SATISFACTION

97.7 %

of network providers agree with our clinical Recommendations

272,095

TOTAL Network Providers

The Cost-of-Care
Workers’ Comp vs. Group Health

50 %

More visits per patient than Group Health

45 %

More likely to receive PT than Group Health

20 %

More modalities per visit than Group Health

The total cost of physical therapy in workers’ compensation is almost three times higher than in group health. But it’s not just the unit cost that’s driving these numbers, it’s the quantity of care (utilization). Workers’ comp patients are not only 45% more likely to receive PT but they receive 50% more visits and 20% more modalities per visit compared to group health patients according to recent research by NCCI.

While there is a modest unit price differential (105% more for workers’ comp than group health), the utilization of physical medicine in workers’ comp is 268% that of group health, making up the vast majority of the total cost differential.

Physical rehabilitation is a critical element of restoring functionality after a work-related injury and ensuring safe return to work but in an industry without cost-sharing mechanisms or co-pays, it is just as critical that the quality care is both effective and efficient. To tackle the cost-of-care challenge, therefore, it is critical to look at not just unit cost but the volume of service.

TRENDING AT MEDRISK

Average Number of Visits and Duration

Duration (Days)
visits
  • 90.0
  • 80.0
  • 70.0
  • 60.0
  • 50.0
  • 40.0
  • 30.0
  • 20.0
  • 10.0
  • 0.0
  • 24.0
  • 22.0
  • 20.0
  • 18.0
  • 16.0
  • 14.0
  • 12.0
  • 10.0
  • 8.0
  • 6.0
  • 4.0
  • 2.0
85.3
76.0
72.1
64.0
48.0
14.3
13.5
13.0
12.7
11.2
  • 2015
  • 2016
  • 2017
  • 2018
  • 2019

Duration (Days)

  • 85.3
  • 76.0
  • 72.1
  • 64.0
  • 48.0

visits

  • 14.3
  • 13.5
  • 13.0
  • 12.7
  • 11.2

Duration (Days)

visits

From 2015 to 2018, MedRisk saw a 11.19% reduction in number of visits per case on average, driven by a combination of factors including quality management practices such as the application of evidence-based guidelines, expert providers, PT-to-PT coaching and clinical recommendations. The duration of care was also down by 24.97%. While controlling visits has an impact on duration of care, technology and electronic integration also speed authorization, facilitate communication and promote faster time to treatment. A steady decline in the percentage of more complex post-surgical cases is also a contributing factor.

* Includes both surgical and non-surgical closed cases from 1/1/2015 to 9/30/2019.

TRENDING AT MEDRISK

Post-Surgical PT Cases Down

  • 2015
  • 2016
  • 2017
  • 2018
  • 2019
23.5%
22.6%
19.9%
17.9%
17.3%
  • 0.0%
  • 5.0%
  • 10.0%
  • 15.0%
  • 20.0%
  • 25.0%

The conservative care movement continues to make an impact throughout the industry. Changes such as Ohio’s PT-first mandate and tighter utilization review controls in California have significantly decreased surgeries and, consequently, post-surgical PT. As such, MedRisk has seen post-surgical cases drop by 26% in the last 5 years. Could this be an early sign that PT is gaining traction as a preventative treatment strategy?

Responding to Evolving Needs

Telerehabilitation

Telerehabilitation

Telerehabilitation

  • Patient Perspective: Sometimes telerehabilitation can be a necessity for faster return to work and not “just” a convenience. A traveling nurse practitioner who conducts in-home patient assessments for a large group health insurance company discovered how telerehab could enable her to meet treatment expectations and continue to work—something that wouldn’t have been possible otherwise.
  • Physical Therapist Perspective: When Jill Carnahan, PT, DPT, began working on telerehab cases at MedRisk, she was skeptical. “The more patients I’ve treated, the more I realized the power of voice. It requires focus, communication and collaboration, but when the patient gets it on their own, you know they really get it.”

Patient Education

Patient Education

PT Consult

  • Physical therapy as first-line treatment can improve patient outcomes, but what about a consultation with a physical therapist? Can a simple conversation in advance of treatment affect outcomes? Research says yes.
  • A 2018 study from the University of Utah found that a discussion between patient and provider about the severity of pain and prognosis can reduce the chance of opioid prescription by up to 65%.
  • A PT consult through MedRisk addresses catastrophic thinking and other negative factors following an occupational injury. For example, a patient may have a standard diagnosis but may express a fear of reinjury during a consultation. This information can be used to inform treatment strategies and prevent delayed recovery.

Pioneering Managed PT

Pioneering Managed PT

Pioneering Managed PT

In 1994, MedRisk offered the Workers’ Comp community the first specialty managed care program for PT services. Since then, we’ve continued to pioneer new programs that improve, enhance or further our understanding of faster, better recovery.

Legislative Recap

MedRisk gathers the latest legislative and regulatory developments and challenges each quarter. Here is a full summary of significant movements in 2019 and the implications for 2020.

NATIONWIDE

Arizona

ARIZONA

ARKANSAS

California

CALIFORNIA

Colorado

COLORADO

ILLINOIS

KENTUCKY

NEBRASKA

NEVADA

NEW YORK

NORTH CAROLINA

VIRGINIA

Research Insights